Tasmania s. Primary Health Services Plan. May Depar tment of Health and Human Ser vices

Transcription

1 Tasmania s Health Plan Primary Health Services Plan May 2007 Depar tment of Health and Human Ser vices

2 Table of contents List of figures and tables 3 1. Summary of actions The primary health approach Health planning principles Service delivery model The prevention and management of chronic conditions General practice Rural health centres Communication and collaboration between service providers Strengthening community participation in primary health The health workforce Quality and safety initiatives Education and training Community transport Introduction and background Background What is primary health care? Definition of primary health care Tasmanian Primary Health Services Policy and planning framework Primary Health Services managed or funded by the Department General practice Home and Community Care services (HACC) Key related services Other private primary health care providers Community and consumer involvement in primary health The primary health activity profile Workforce profile Transport Assessment of future health care needs Tasmania s changing community Hospital use and projected demand Implications of delivery profile/future service demand The importance of Primary Health Services Issues arising from current service delivery profile and expected future demand 43 Primary Health Services Plan

3 7. Directions and actions The primary health approach Health planning principles Service delivery model The prevention and management of chronic conditions General practice Rural health centres Communication and collaboration between service providers Other factors influencing service system sustainability Primary Health Services: Community profiles Southern region: Rumney Southern region: Wellington Southern region: Fawkner Northern region: South Esk Northern region: North Esk North West region: Mersey North West region: Hellyer Implementation and evaluation Implementation processes Evaluation processes Glossary Appendices Developing the Primary Health Services Plan: Project governance and activities Results of the consultations Other related policy and planning frameworks Other related community health services Bibliography Primary Health Services Plan

4 List of figures and tables Table 1 Department operated rural inpatient facilities 18 Table 2 Department funded rural inpatient beds 19 Table 3 Australian Government-funded Regional Health Services 22 Table 4 Top 10 Youth Health Services delivered in Table 5 Per cent of GP services bulk-billed by Federal Electorate 27 Figure 1 Home and Community Care services by type of service delivered Table 6 HACC services: Number of clients assisted by age group 28 Table 7 HACC services: Number of clients by selected service type 29 Table 8 HACC services: Units of service delivery by service type 29 Table 9 Aged care places, ACAT region, June Table 10 GP numbers and Full-Time Equivalents per 1000 population Tasmania Table 11 Primary Health Nurses (Headcount by age group and award/stream) Table 12 Primary Health allied health employees by age group, Figure 2 Primary Health allied health employee by profession, Figure 3 Population aged 65 and over by LGA (2003) 36 Figure 4 Projected change by age in the Tasmanian population, 2006 to Figure 5 Projected change (%) in resident population by LGA 2006 to Table 13 Socio-economic Index of Disadvantage, State and Territory, Figure 6 Socio-economic Index of Disadvantage, Tasmanian LGAs, Figure 7 Projected hospital separations for diabetes, to Table 14 Health risk factors, Tasmania and Australia, various years 40 Table 15 Projected demand for outpatient services by LGA 42 Figure 8 Primary Health Services by LGA 44 Figure 9 Activity, cost per occupied bedday, to Figure 10 Activity, annual cost per occupied bed, to Figure 11 Activity, cost, community nursing occasion of service, to Figure 12 Comprehensive model of prevention and management of chronic conditions 58 Figure 13 Primary Health Services areas 73 Figure 14 Rumney 74 Table 16 Departmental services: Clarence municipal area 75 Table 17 Departmental services: Glamorgan Spring Bay municipal area 76 Table 18 Departmental services: Sorell municipal area 78 Table 19 Departmental services: Tasman municipal area 79 Figure 15 Wellington 80 Table 20 Departmental services: Hobart municipal area 81 Primary Health Services Plan 3

5 Table 21 Departmental services: Huon Valley municipal area 82 Table 22 Departmental services: Kingston municipal area 85 Figure 16 Fawkner 86 Table 23 Departmental services: Brighton municipal area 87 Table 24 Departmental services: Central Highlands municipal area 88 Table 25 Departmental services: Derwent Valley municipal area 90 Table 26 Departmental services: Glenorchy municipal area 92 Table 27 Departmental services: Southern Midlands municipal area 93 Figure 17 South Esk 95 Table 28 Departmental services: Launceston municipal area 96 Table 29 Departmental services: Meander Valley municipal area 98 Table 30 Departmental services: West Tamar municipal area 100 Figure 18 North Esk 102 Table 31 Departmental services: Break O Day municipal area 103 Table 32 Departmental services: Dorset municipal area 106 Table 33 Departmental services: Flinders Island municipal area 108 Table 34 Flinders Island: Australian Government OATSIH-funded service June Table 35 Departmental services: George Town municipal area 110 Table 36 Departmental services: Northern Midlands municipal area 111 Figure 19 Mersey 114 Table 37 Departmental services: Central Coast municipal area 115 Table 38 Departmental services: Devonport municipal area 116 Table 39 Departmental services: Kentish municipal area 117 Table 40 Departmental services: Latrobe municipal area 118 Figure 20 Hellyer 119 Table 41 Departmental services: Burnie municipal area 120 Table 42 Departmental services: Circular Head municipal area 121 Table 43 Departmental services: King Island municipal area 123 Table 44 Departmental services: West Coast municipal area 124 Table 45 Departmental services: Waratah-Wynyard municipal area 128 Table 46 Consultation schedule: November-December Table 47 Consultation schedule: March-April Table 48 Respondents to the Primary Health Services Issues Paper Primary Health Services Plan

6 1. Summary of actions 1.1 The primary health approach A primary health approach will be promoted throughout the network of primary health services to guide day-to-day practice and to better meet the needs of Tasmania. Key elements of the primary health care approach include: a focus on health and wellbeing, not just illness; a population perspective on health, not only for individuals; a multi-disciplinary team approach to care; a partnership approach in which a range of groups and organisations need to work together on improving health; a focus on actual health needs, such as chronic disease, rather than service needs; and fostering individuals control over their health and participation in health decision making. Each health centre will have a role in working with key stakeholders and the local community to design and implement programs to support healthy life conditions and choices, and address local causes of illness and injury. There will be an expansion of the number of Health Promotion Coordinators by four positions throughout the state, and integration of health promotion approaches across the primary health workforce. 1.2 Health planning principles To meet the objective of designing a primary health system that can better meet the changing needs of the Tasmanian community, primary health services will be based on the following health planning principles: 1. The services provided by Tasmania s primary health services should be: accessible as close as possible to where people live as long as they can be provided safely, effectively and at an acceptable cost; appropriate to the community s needs; client- and family-focused; integrated with the other elements of the health service system; designed for sustainability; focused on health promotion, illness prevention and early intervention; and delivered in a culturally appropriate manner. 2. Where services cannot be delivered safely, effectively and at an acceptable cost from within local communities, access to services should be facilitated through service coordination, the provision of outreach services from an external base, the use of technology, transport assistance and other appropriate community support. 1.3 Service delivery model A tiered service delivery model establishing an integrated network of primary health services across Tasmania has been applied to all services delivered by the Department of Health and Human Services (the Department). Tiers 1-3 represent primary health service sites and have been developed considering current and future needs, specifically: Primary Health Services Plan 5

7 population trends and levels of community need; distance from other services; and sustainability considerations such as cost and workforce availability. Tier 1 sites provide core primary health and community care services within a local community. They reflect the increasing emphasis on community-based and home-based care and the provision of these services through an integrated team approach. Tier 2 sites operate rural inpatient services (subacute beds) in addition to their primary health and community care services. Tier 3 sites provide extended primary health services with significant outreach across the network and a stronger representation of acute services, including integrated care centres developed in association with the Acute Health Services Primary health services will also be provided within Tier 4 integrated care centres in a hospital setting and would be of a more complex nature. The state-wide model set out in this Plan will be applied to existing service sites: Tier 1 Sites that provide core primary health services: Bridgewater, Bruny Is, Burnie (Jones St), Cape Barren Island, Cygnet, Huonville, Kings Meadows, Ouse, Ravenswood, Risdon Vale, Rokeby, Rosebery, Sorell, Strahan, Swansea, Spring Bay (Triabunna), Ulverstone, Westbury, Wynyard and Zeehan. Tier 2 Rural sites that provide both Tier 1 level services and inpatient services: 1 Beaconsfield, Campbell Town, Deloraine, Dover (Esperance MPC), Flinders Island, Franklin (Eldercare), George Town, King Island, New Norfolk, Nubeena (Tasman MPS), Oatlands, Queenstown, Scottsdale, Smithton, St Helens, and Swansea (May Shaw Nursing Centre). Tier 3 Sites that provide extended primary health services with significant outreach across the network and incorporating over time a stronger representation of acute services: Burnie (Parkside); Devonport; Launceston (developing into a Tier 4 integrated care centre over time), Glenorchy, Kingston (upgraded over time from its current Tier 1 status), Clarence and Hobart (Repatriation Centre). 1.4 The prevention and management of chronic conditions Community-based health services will be changed and expanded over time to better respond to the changing needs of the Tasmanian population. Service change will be implemented to enable: greater capacity to treat diabetes and other chronic diseases at the primary health level; greater access to home-based services such as post-acute care and specialised community nursing; more emphasis on health promotion; working with young people, through collaborative partnerships, to adopt healthy lifestyles; development of new models to expand rehabilitation services in the community; increased access to mental health and alcohol and drug programs in rural areas; and an expansion of the approaches to chronic disease self-management. Each health centre is to have a role in working with key stakeholders and the local community to design and implement programs to support healthy life conditions and choices, and address local causes of illness and injury. 6 Primary Health Services Plan 1 For comment on St Marys and Longford, see Rural Health Centres, 1.6.

8 1.5 General practice A new relationship between general practice and the Department of Health and Human Services will be established that better supports the sustainability of the sector and provides additional capacity to respond to the challenges of chronic disease: the Department will work with general practice representatives to progress general practice provision of state-funded community health services; a demonstration site in Launceston will be developed and operational within one year; a consistent Departmental policy concerning the availability of support arrangements for general practice will be developed in collaboration with general practice organisations; closer links will be developed between rural General Practitioners and acute hospitals, especially for training and support; co-location of general practice and state health services will occur where this is possible and would benefit service arrangements; funding demonstration sites, in both urban and rural communities, of new chronic disease/ community and population health initiatives using a team approach incorporating community health and general practice; and following the evaluation of demonstration sites, as benefits are proven and resources become available, it is envisioned that these initiatives will become established elements of Tasmania s primary health service system. 1.6 Rural health centres A changed and expanded role for rural health centres will be implemented to ensure these services better meet the needs of the Tasmanian population and their local communities. This will include: greater access to home-based services such as post-acute care; increased day respite services; more health promotion and management of chronic disease; increased access to community nursing; and increased access to visiting services such as allied health or mental health services. In applying the health planning principles to rural health sites within Tasmania, it is clear that some are not meeting the criteria established to demonstrate sustainability. It is not possible for them to deliver the current service to their community in a way that is safe, effective and at an acceptable cost. Nor will it be possible to continue to provide these services in the future when workforce issues worsen. Consultation has occurred with the communities of St Marys, Ouse and Rosebery in relation to this issue. Work is now occurring to develop models of service that will better meet their needs on a more sustainable basis. Ouse and Rosebery will be developed as Tier 1 sites in the short term. The recruitment of a General Practitioner remains very difficult within the current service model at the St Marys Community Health Centre and maintaining it at a Tier 2 level is not sustainable in the long term. The Department has recently received a submission which raises the potential for a new approach to the delivery of services in the Break O Day municipality. This requires further investigation and extensive consultation with the communities of St Marys and St Helens before a firm direction can be established. This proposal may provide significant improvement in health services for the whole municipality and deserves further consideration. The two beds at Longford are exclusively utilised for aged care and discussions will occur with the management of the nursing home as to their appropriate future use. Primary Health Services Plan 7

9 Monitoring services against standards of quality, safety and sustainability is an ongoing process and, as the needs of the community change, and as health workforce issues arise, the roles of rural health centres may need to change. Changes in inpatient services will include: planned overnight non-medical respite as required (Rosebery and Ouse); and increase in inpatient beds in two sites (New Norfolk, and over time in Swansea). All rural health centres which require an emergency response role will continue to have the appropriate facilities to enable on-site care of minor injuries as well as (where necessary) stabilisation and transfer of those patients who are seriously unwell or injured. 1.7 Communication and collaboration between service providers Improved communication and collaboration between service providers will be a priority: through the establishment of Clinical Networks across the acute, primary and other services, especially in relation to emergency medicine, aged care, rehabilitation and obstetrics; through the development of cross-program integrated care centres, to extend dialysis and chemotherapy services to some community-based sites, facilitate the introduction of more afterhours general practice clinics and work together to develop processes to deliver more specialised care in the community; through a redefinition of the role of Community Nursing in order to provide more acute level care in the community, for example cancer nurses, Hospital in the Home arrangements; through the development of Community Health in-reach services into the major hospitals; through the development of consultation, liaison and outreach services from Alcohol and Drug Services and Mental Health Services to primary health centres; through the development of Home and Community Care services which prevent or delay decline and promote client independence (with a percentage of the funding allocation attributed specifically to rural and remote areas); and through the development of Primary Health Partnerships at the local level incorporating both local service providers from general practice, non-government organisations and State and Local Government as well as community representation. 1.8 Strengthening community participation in primary health In addition to existing processes, the following priority actions will be taken to strengthen community participation in primary health: the development of Departmental community and consumer engagement policies and processes; strengthening community and consumer engagement through engagement with community representatives, local government and community organisations in local Primary Health Partnerships; and the development of regional consumer engagement processes involving Primary Health and Acute Health services that will provide an opportunity for community representatives to be involved in the implementation of the Tasmanian Health Plan, along with service providers, local government and other stakeholders. 1.9 The health workforce The new health service models arising from the planning process generate a specific set of health workforce issues that require an overarching health workforce plan. This will include a long-term strategy to link Tasmania s workforce needs to health care education and training and research. Priority actions include: 8 Primary Health Services Plan

10 increased support, through General Practice Workforce Tasmania, to aid in the recruitment of general practitioners to Tasmania; implementation of Nurse Practitioners working in rural health teams in 2008; consideration of new workforce models to meet the new service requirements eg generic health degrees that will equip health providers to undertake lifestyle counselling and support in relation to chronic disease, increased utilisation of therapy assistants, direct care providers; expanded scope of practice for rural paramedics; and consideration of retention strategies that can assist existing health professionals to stay in the workforce Quality and safety initiatives In addition to existing processes, the following priority actions will be taken to address service quality and patient safety issues: The results of the clinical role delineation (Capability Framework) assessment will be applied to rural inpatient sites. In the event that services do not have appropriate access to clinical support services, an appropriately skilled and available workforce, equipment, suitable facilities and appropriate capacity to maintain clinical standards, alternative arrangements for delivery of services will be considered. The clinical role delineation process will be extended to Community Health Centres. External accreditation of broader primary health care services will be established to underpin the quality agenda, and to ensure the community can have confidence in its services. This will augment the well-established accreditation system for general practice and residential aged care. All Community Health sites will be subject to a quality auditing system Education and training The Department of Health and Human Services will work with the University of Tasmania and other educational providers to provide sustainable health workforce training and development, including a commitment to vocational, undergraduate and postgraduate student placements in primary health care and multi-disciplinary settings. Actions include: strengthening the Partners in Health agreement with the University in order to further develop primary health research and education in this state; undertaking research and evaluation of the outcomes of demonstration sites established as part of the implementation of the Primary Health Services Plan; exploring the potential to expand allied health tertiary education within Tasmania including consideration of addressing priority workforce issues such as access to physiotherapy, nutrition, dietetics; further development of a degree course for Environmental Health Officers in Tasmania; working with the University to examine the feasibility of a Primary Health Clinical Education Centre at the Clarence Community Health Centre providing inter-professional learning experience for medical, nursing and allied health staff in a community based setting. General practice services to the community will continue under this arrangement; working with the University to examine the feasibility of developing the Launceston General Hospital precinct as an enhanced primary/secondary Education Centre providing interprofessional learning for health professional students; developing all Rural Health Centres as Rural Health Teaching sites; and increased workplace clinical psychology training across the Department. Primary Health Services Plan 9

11 1.12 Community transport Access to community transport will be improved. The Department of Health and Human Services will commence a project to establish community transport networks that will better coordinate and improve transport options for people attending health care services where public transport either is not available or is inappropriate. To advance the project, the following actions will be undertaken immediately: provision of additional funding to assist in meeting the needs of people who are transport disadvantaged but outside the Home and Community Care target group to access transport for non-urgent health-related needs; and engagement of a project manager to maintain linkages with the Department of Infrastructure, Energy and Resources, map existing resources, develop a working model and project plan and undertake the necessary liaison with the community sector and local communities to engage them in the process. The Home and Community Care program will continue to expand the community transport resources in line with the established needs of its target population. 10 Primary Health Services Plan

12 2. Introduction and background The Tasmanian health system is under intense pressure and must initiate a health reform program as a matter of urgency. The proposed reform program described in this paper has been the subject of wide consultation with health organisations, and the community and has been informed by external experts and consultants. The impetus for reform comes from a number of quarters simultaneously. At the base is an increasingly ageing population coupled with an epidemic of chronic disease. This epidemic will continue to worsen while the health risk factors for chronic disease in the community remain high. In other words Tasmanians are in the midst of a chronic disease epidemic that must be dealt with now and we must also deal with the causes if we are to stem the tide in the future. At the same time there are escalating costs in our hospitals, problems in recruitment and retention of health professionals and a clear mismatch between current services and the changing needs of the community. This means Tasmania has a system that is unsustainable and not able to respond to the challenges it faces. The proposed reforms describe a way forward to address each of these challenges: Strengthening the primary health care system to better respond to the chronic disease epidemic. These services will focus on reducing the level of risk in the community and provide the means for early identification and intervention in chronic disease. This approach will also provide the means to support people to better manage their chronic condition in the community. Working with our acute health services, specifically the major hospitals, to assist them to better respond to clinical demands coming from an ageing population and a heavy chronic disease burden. These reforms centre on achieving efficiencies, improved integration and clarifying roles and responsibilities. Many services currently offered by major hospitals can be provided in other community settings and the reforms describe how that can be achieved. The financial status of the health system has meant that the reforms must be balanced and timed to ensure they are affordable, although it is recognised that implementation will require investment into critical change management issues. The reforms have been designed within the parameters of well established health planning principles. While they will require some changes to some services, these, in their current form, are the least sustainable of our services. While other States and Territories are experiencing similar issues, Tasmania s health is deteriorating at a rate worse than other States. In response, this reform program represents the first time that a jurisdiction has responded in a comprehensive and state-wide way covering both hospital and community programs and services. We have strong support from health leaders across the State for the implementation of these reforms. All understand that the current system must change and we are committed to the changes. We need to design our health care system carefully to ensure that quality care is accessible to all Tasmanians on a fair and equitable basis. We have a strong foundation on which we can build, but there is a clear imperative to change and to position our health care system to meet future demands and challenges. Primary Health Services Plan 11

13 2.1 Background On 5 December 2006, Lara Giddings MHA, Minister for Health and Human Services, launched a discussion paper A Primary Health Strategy for Tasmania and urged all Tasmanians to have their say on the future of the State s primary health care services. 2 Within three months, 72 responses had been received from a broad range of individuals, as well as professional and community organisations. These responses, and the outcomes of local consultations and workshop discussions, were collated and analysed, and used in the development of an Issues Paper, launched by Minister Giddings on 27 March A further 74 responses to the Issues Paper, and further local consultations, have informed the Primary Health Services Plan. Appendix 1 provides details on the development of this Plan. The initial work of the Primary Health Services Plan project team has been subject to a Quality Review process undertaken by Professor Judith Dwyer, of Flinders University, one of Australia s recognised experts on health system design and primary health care. Dr Felicity Jefferies, Chief Executive Officer (CEO) of the Western Australian Centre of Rural and Remote Medicine and Mr Kim Snowball, a Western Australian rural health policy expert and service manager, both well known for their expertise in rural health, have also worked with the Primary Health Services Plan project team and stakeholders to inform the development of the service model and final Plan. Appendix 2 summarises the results of this consultation process. Both the Primary Health Services Plan and the Clinical Services Plan are being informed by an acute (hospital) services demand projection project commissioned by the Department of Health and Human Services for use in both Plans and in joint research and planning on interface issues across the primary and acute systems. 12 Primary Health Services Plan 2 Department of Health and Human Services (2006) A Primary Health Strategy for Tasmania, Discussion Paper, DHHS: Hobart 3 Department of Health and Human Services (2007) Primary Health Services Plan Issues Paper, DHHS: Hobart

14 3. What is primary health care? 3.1 Definition of primary health care Every time Tasmanians visit their General Practitioner (GP), or have a prescription filled at a pharmacy, or consult with a community nurse or health care worker, they are accessing primary health care. Primary health care is defined by the World Health Organisation as: essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain It is the first level of contact of individuals, the family and the community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. 4 Responsibility for delivering primary health services in Australia lies with all tiers of Government, with the private sector, and with community sector organisations. Funding responsibility for primary medical services mainly rests with the Australian Government, although State Governments, local communities and individuals are contributing increasing amounts to pay for these services. The Australian Government contributes significantly to primary health services in Tasmania, through a range of programs, including funding general practice service delivery (through access to the Medicare Benefits Schedule) and support. 5 The Australian Government also supports the operation of General Practice Tasmania. 6 The development of a collaborative approach with other funders or providers, in particular the Australian Government, will be a key success factor in the development of the Primary Health Services Plan. The primary health approach is characterised by: Area-based planning for the health care needs of local communities stemming from a population health approach to health care planning. Considering the needs of all the population within a given area, not just those accessing health services. A social model of health ensuring health and wellbeing is improved by addressing social and environmental determinants of health, in tandem with biological and medical factors. The health care system working collaboratively with other sectors to address the social and environmental factors that inhibit wellbeing. 7 4 World Health Organization (2002) Primary Health Care Review Project Region Specific Report. Regional Office for the Western Pacific: Manila, Philippines. 5 This includes an expanded model of general practice that involves practice nurses, GPs and other services through the More Allied Health Services (MAHS) program and mental health services through the Better Outcomes in Mental Health program. More information on the Australian Department of Health and Ageing may be found at 6 The General Practice Tasmania network supports contemporary general practice in Tasmania by linking GPs with each other, by supporting all members of the general practice team and, increasingly, by enabling, supporting and/or closely liaising with allied health professionals as part of the primary health service team. More information on the General Practice Tasmania network may be found at 7 Victorian Government Department of Human services (2006) Care in Your Community: A planning framework for integrated ambulatory health care, State of Victoria: Brunswick. Primary Health Services Plan 13

15 4. Tasmanian Primary Health Services 4.1 Policy and planning framework As a result of consultations concerning the development of a Primary Health Strategy for Tasmania, eight key areas for action have been identified. These are: 1. Service coordination: Service coordination strategies will place consumers and communities at the central focus of service delivery. 2. Quality and safety: Primary health care services will meet appropriate standards of quality and safety. 3. Partnerships: Strengthening partnerships with the Australian Government, Local Government, the University of Tasmania, general practice, the non-government sector, and private providers will deliver better primary health care services critical to future system sustainability. 4. Promoting health, wellbeing and resilience; illness and injury prevention; early intervention: Promoting health, resilience and wellbeing, and enabling people and communities to increase capacity to manage their own health will represent a major change in the approach to primary health care services in Tasmania. 5. Continuum of chronic disease prevention and management: A primary health care system will encompass both treatment services to individuals and services to improve both individual and community wellbeing, recognising these as complementary, not competing, services. 6. Workforce development: Workforce development is integral to the major changes facing primary health care services, and to ongoing workforce sustainability. A more flexible approach to vocational, undergraduate and postgraduate training, new job structures and ongoing commitment to training and skill enhancement by the Department, University of Tasmania, the Vocational Education and Training sector and service providers, will be key elements for a sustainable future workforce. Partnerships between the Tasmanian and Australian Governments must be expanded and enhanced to create further opportunities the development of the state s workforce education. 7. Planning and funding service delivery models that are accessible, flexible, equitable and sustainable: The Primary Health Services Plan will provide the blueprint for service delivery for the next five years, addressing the distribution of services across Tasmania, taking into account demographic and health status considerations. 8. Developing facilities and other infrastructure that support contemporary service models: There is a strong agreement that physical infrastructure can best support the optimal provision of services to the community through flexibility of design and alignment to an integrated service model and that the availability of transport services in the local community and between communities is a critical factor in our capacity to meet the health needs of Tasmanians Links with other planning processes The Department has developed a strategic framework for health service delivery in Tasmania the Tasmanian Health Plan. The Tasmanian Health Plan is an overarching document which sets the future direction for a high-quality, sustainable, responsive, and integrated health system to meet the future needs of the Tasmanian community. 14 Primary Health Services Plan

16 The Tasmanian Health Plan is supported by: The Primary Health Services Plan (this document); and The Clinical Services Plan. Appendix 3 details a range of policies and planning processes that have been undertaken at national or state-wide level prior to the development of this Plan. Other current planning processes are listed below. Clinical Services Plan The Department has developed a Clinical Services Plan to define the roles, services, and strategic directions for Tasmania s three major public acute hospitals the Royal Hobart Hospital, Launceston General Hospital, and the North West Regional Hospital (Burnie and Mersey campuses) to the year The Acute Clinical Services Plan also provides the foundation for strategic facility planning and management in this area Aged and Rehabilitation Services Plan (Draft) The Department has commissioned the development of a strategic plan for Aged and Rehabilitation Services in Tasmania. This plan assessed the existing provision of rehabilitation services in Tasmania (identifying current gaps in service delivery), reviewed models of best practice, and included recommendations for the future delivery of aged and rehabilitation services in Tasmania, including the implications of future service delivery. Strategic framework for State-wide Cancer Services (Draft) This framework is being developed by the Department and clinicians across Tasmania s health system. This framework promotes the development of a cohesive, integrated, state-wide approach to cancer control that draws on the best available evidence, builds on national and international experience of success and seeks to enable services to equal or exceed international benchmarks of effectiveness. The framework will underpin the future development of a Tasmanian Cancer Plan which will identify planning priorities and objectives for cancer services in the short, medium and longer term. Review of Alcohol, Tobacco and Other Drug Treatment Services in Tasmania The Department of Health and Human Services is currently undertaking a review of alcohol, tobacco and other drug treatment services in Tasmania. It is anticipated that the review will provide clarity around the range, scale and capacity of existing services provided in Tasmania and a comprehensive, cohesive plan for future policy and service development; including a framework for the development of the sector in order to achieve the principles and objectives of the Tasmanian Drug Strategy Tasmania s Diabetes Action Plan The Tasmanian Government has developed a diabetes action plan aligned to the Council of Australian Government (COAG) policy directions for diabetes reform. The plan sets out clear goals for the reduction of the incidence of diabetes within the state. The three major policy directions are as follows: primary prevention to target the known modifiable lifestyle risk factors associated with Type 2 diabetes; early detection and intervention for Type 2 diabetes; and improved integrated care and self-management for those recently diagnosed, or with established Type 2 diabetes. These directions have been taken into account in the development of the Primary Health Services Plan. Primary Health Services Plan 15

17 4.2 Primary Health Services managed or funded by the Department Departmental structure Within the Department of Health and Human Services, the Community Health Services Group is responsible for primary health, along with other non-acute health and community support services. Details on related Community Health Services programs are set out in Appendix 4. Primary Health Services provides a broad range of services through a number of community health centres across Tasmania. This section of the Department also includes small rural health facilities which provide inpatient care and some aged care, and act as a base for community health and domiciliary services. This grouping also reflects a focus on the needs of people in rural and remote communities. The Department s Primary Health Service has recently been structured as three geographic areas, aligned geographically to the three major hospitals in Southern Tasmania, Northern Tasmania and the North West. There is a further clustering of services at a district level, each containing a number of Local Government Areas. These have been developed to provide a network of services around Tasmania that balances accessibility with sustainability, providing the economies of scale associated with larger groupings of services. As part of this planning process there has been an alteration to the structure in the North West to achieve better linkages and integration. The Department s Primary Health Coordination areas are: Fawkner: Derwent Valley, Central Highlands, Southern Midlands, Glenorchy and Brighton Wellington: Hobart, Kingborough and Huon Valley, Rumney: Clarence, Sorell, Tasman and Glamorgan Spring Bay North Esk: Break O Day, Dorset, Flinders Is, Northern Midlands and George Town South Esk: Launceston, West Tamar and Meander Mersey: Latrobe, Kentish, Devonport and Central Coast Hellyer: Burnie, Circular Head, King Island, Waratah-Wynyard and West Coast The Department s Primary Health Coordination areas are illustrated in Figure 12 on p 73. The Primary Health Coordinators will be a key resource in the implementation of the Primary Health Services Plan. They will be responsible for: encouraging, mentoring and supporting the site/service managers/team leaders in providing existing services effectively and efficiently; managing key change initiatives and responding to significant service issues arising within a designated cluster of municipal areas (eg workforce); leading service quality improvement review and service development; working with local councils and other stakeholders to identify service gaps and priorities, and working to address identified gaps (including working with rural GPs to promote sustainable services) Community Health Centres There are 23 community-based health centres in Tasmania. These offer a range of services for local residents depending on their individual health care needs. 16 Primary Health Services Plan

18 Community Health Centres do not offer inpatient services. Many Community Health Centres provide accommodation and meeting space for visiting services from other regions, including services provided by hospital, housing, disability, and family and child health services. 8 The services offered vary between Community Health Centres, depending on the needs of the local area, but may include counselling and support services, health promotion activities and medical, nursing, and allied health assistance. Support services Support services may include: alcohol and drug programs counselling Day Care Centre programs home help, home maintenance and personal care housing services rehabilitation programs transport volunteer assistance. Health promotion health education health promotion. Medical, nursing and allied health A range of medical, nursing and allied health services may include: community nursing family and child health services general practice medical services mental health services oral health services post-acute care assistance social work, occupational therapy, physiotherapy, podiatry and speech therapy youth health services. Community Health Centres are located in: Bridgewater, Bruny Island, Burnie, Cape Barren Island, Clarence, Clarence Plains, Cygnet, Devonport, Glenorchy, Huonville, Kings Meadows, Kingston, New Norfolk, Ravenswood, Risdon Vale, Sorell, Strahan, Swansea, Spring Bay (Triabunna), Ulverstone, Westbury, Wynyard, Zeehan Community health services are also provided from larger service centres in: Hobart (Repatriation Centre), Launceston (John L Grove, Allambie) and Burnie (Parkside) 8 Family and Child Health is a primary health service delivered through Human Services (which is also responsible for the Child Protection Services; Adoption and Information Service; Family Violence Counselling and Support Service; and Sexual Assault and Support Service). Primary Health Services Plan 17

19 4.2.3 Rural inpatient facilities Tasmania has 158 rural health inpatient beds provided through 20 inpatient facilities: 144 beds (15 facilities) run by the Department and 14 inpatient beds (five facilities) funded by the Department and run by other organisations. There are four stand-alone facilities with under 11 beds, and all have under 50 beds. Fourteen facilities also have aged care facilities, and in these cases, most have very small numbers of inpatient beds (between two and eight). As discussed in Section 8 of this Plan, there are a range of issues associated with the sustainability of the current service delivery profile illustrated in Table 1 below. Table 1 Department operated rural inpatient facilities Name/Location 9 Inpatient (subacute) beds Beaconsfield District Health Service (Multi Purpose Service) Campbell Town Health and Community Service (Multi Purpose Service) Deloraine Hospital Flinders Island Multi Purpose Centre George Town District Hospital & Community Health Centre Health West Rosebery Hospital Health West West Coast District Hospital, Queenstown King Island Hospital and Health Centre Midlands Multi Purpose Health Centre Oatlands New Norfolk District Hospital North East Soldiers Memorial Hospital Scottsdale Residential aged care beds total beds Other services Respite, palliative and post-natal care. Community and visiting services and support groups Day centres, information, advocacy, home visiting, social support, recreation, referral, co-ordination, podiatry, equipment hire and provision of rooms for general practice Coordinate a broad range of community and allied health services within Meander Valley Coordinate a broad range of community, visiting services and support services, and provision of rooms for general practice Visiting services. Base for community nursing, home help/personal care and home maintenance Visiting diabetic clinic, needle exchange. Coordinate community nursing and other support programs, and provision of rooms for general practice Visiting radiology, diabetic clinic, physiotherapy, podiatry. Community nursing, home help/personal care and home maintenance, and provision of rooms for general practice Coordinate community services, visiting service and community nursing, child health, dental, antenatal, and alcohol and drug services, and provision of rooms for general practice Coordinate delivery of community and visiting services including community nursing, child health, disability and diabetic education services, and provision of rooms for general practice Radiology, physiotherapy, podiatry, community health, mental health, child health and visiting consultants Radiology, physiotherapy, visiting services to Scottsdale and communities. Provision of community nursing and home help/personal care. 18 Primary Health Services Plan 9 Under the terms of the Multi Purpose Agreements, funds can be used flexibly according to community need. 10 A full list of services provided at each facility is contained in Chapter 8.

20 Name/Location 9 Inpatient (subacute) beds Ouse District Hospital Smithton Hospital St Helens District Hospital St Marys Community Health Centre Residential aged care beds total beds Other services Visiting family child health, podiatry, physiotherapy, mental health, diabetes education. Outreach: occupational therapy and speech pathology, and provision of rooms for general practice Visiting radiology, diabetic clinic, obstetrics and continence services. Provision of community nursing, home help/personal care and home maintenance Radiology, physiotherapy, and visiting services Visiting physiotherapy, podiatry, audiology. Community nursing base, home help/community care, home maintenance, and provision of rooms for general practice. Total Source: Department of Health and Human Services The Departmentally funded inpatient beds are also provided at the following sites. Table 2 Department funded rural inpatient beds Name/Location 11 May Shaw Nursing Centre (Swansea) Tasman Multi Purpose Service Esperance Multi Purpose Centre Inpatient (subacute) beds Other services 2 Provides services to the elderly and disabled including residential aged care, allied health and other professional services, meals on wheels, young and disabled support, centre activities, and community care packages and other brokerage services. 2 Provides a range of health and community services including residential aged care, visiting services, clinics and support groups. The centre is run by local government and is funded by both the State and Australian Government. 2 Provides residential aged care beds, plus a range of community services, visiting services and community groups. The centre is run by local government and is funded by both the State and Australian Government. Huon Eldercare 6 Provides residential aged care and is run by a non-government organisation. Toosey Aged and Community Care Source: Department of Health and Human Services 2 Provides residential aged care, independent living units and community care. It is run by a non-government organisation Regional primary health services A range of services are provided across the primary health areas on a regional basis. The Primary Health Area managers work across these larger areas to develop integrated services both within the Department and across the broader health sector. Palliative Care Service The Palliative Care Service is a specialist service within Primary Health. The specialist, interdisciplinary consultancy team provides consultancy, support, advice and care to people living with a life-limiting illness, their families and carers. Specialist palliative care clinicians work within a consultancy framework across the whole health sector to support primary health service providers in urban and rural areas in the provision of quality palliative care. 11 Under the terms of the Multi Purpose Agreements, funds can be used flexibly according to community need. Primary Health Services Plan 19